Original InvestigationsHepatitis C screening strategies in hemodialysis patients★,★★
Section snippets
Study design
A decision-cost analysis was performed using a simulation model of 5,000 hemodialysis patients who were followed up for 5 years.17, 18, 19, 20 A period of 5 years was arbitrarily chosen because the natural history of patients infected with HCV is not well understood, although substantial liver disease is seen in patients referred for renal transplantation. MEDLINE was searched between the years 1992 and 2000 using different combinations of the following key words: hepatitis C, hemodialysis, and
Results
Using baseline biochemical ($6.31), serological (ELISA, $20.30; SIA, $58.30), and viral ($74.20) test costs, serological-based screening was the least costly screening strategy. The cost of screening per patient in our hypothetical hemodialysis cohort was $382 for biochemical-based screening, $195 for serological-based testing, and $696 for viral-based screening. Total costs for screening the hypothetical cohort for the 5 years were $1,908,524, $975,965, and $3,480,506 using the biochemical,
Discussion
HCV infection has important implications. Infected patients must be identified to encourage alcohol abstinence and be advised of their potential for transmission. For instance, infected patients should not share toothbrushes, razors, and combs or hairbrushes with close contacts to avoid transmission.9 Hemodialysis patients continue to be at increased risk for HCV infection despite the implementation of universal precautions and decreased need for blood products with the use of erythropoietin.39
Acknowledgements
The authors thank David Ly for data collection.
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P.M. and H.F.Y. contributed equally as senior authors.
Supported in part by award no. DK 02450 from the National Institute of Diabetes and Digestive and Kidney Diseases (H.F.Y.); American Association for the Study of Liver Diseases/Schering Award (S.S.); and National Service Research Award no. DK07180-2 from the National Institutes of Health (S.S.).
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Address reprint requests to Sammy Saab, MD, Division of Digestive Diseases, 44-138 CHS (MC 168417), UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095. E-mail: [email protected]
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